Methods and Techniques in Radiotherapy I

Knowledge acquired in the curricular units of Medical Image Processing, Radiobiology and Equipment and instrumentation in Medical Imaging and Radiotherapy

This is a Curricular Unit (CU) central to the training of future graduates, in which content will be taught on the techniques of external radiotherapy and brachytherapy treatment available in a radiotherapy service.

The teaching methodologies described above, in theoretical terms, aim to introduce new core subjects of the Degree and consolidate contents taught in previous CUs. The use of the expository-active method calls for the use of multimedia contents as an aid to the exhibition. The participation of students will be encouraged in order to understand the content taught.

The theoretical-practical aspect will appeal to the reasoning elaborated in relation to the contents of the UC, in this sense it will appeal to the simulation in class of clinical problems/examples aimed at raising technical-professional awareness in Medical Imaging and Radiotherapy.

The student must acquire knowledge about:

– Types of treatment

– Techniques of External Radiotherapy and Brachytherapy, used for treatments with Ionizing Radiation, allowing for their understanding and identification.

The student must acquire skills to:

– Recognize treatment techniques regarding their therapeutic indication

– Identify, choose and build adequate positioning and immobilization means for each situation, taking into account the patient’s technique, pathology and physical condition. Know the radiation sources used in each technique and their main applications and areas of action.

The student must acquire skills to:

– Use, apply and reproduce treatment techniques and protocols

– Use the appropriate positioning and immobilization means

– Use treatment verification systems

– Apply the concepts of radioprotection to the patient and the professional

Evolution of Radiotherapy

Radiotherapy modalities: EXTERNAL and BQRT

External Radiotherapy Techniques:

 – 3D-3DCRT Conformational

 – Modulated Intensity -IMRT/VMAT

 – Guided Image -IGRT

 – Cranial Stereotactic RT

 – Stereotactic body Radioitherapy – SBRT

 – Adaptive Radiotherapy

 – SGRT

Intracavitary and Endoluminal Interstitial Brachytherapy

Plesiotherapy

Special techniques

Tomotherapy Unit

RT with Protons

Carbon ion beam therapy

Intraoperative radiotherapy
Mobility control of internal organs (gating, active breathing control, diaphragm compression and tracking system)

Theoretical/Practical Classes:

1. Planning CT (Lasers, tatoos, positioning accessories, immobilizations and acquisition protocols)

2. Virtual Simulation

3. Linear accelerators (imaging modalities for verification: EPID and Portal imaging; CBCT; Imaging protocols: Online/offline matching)

4. Irradiation techniques ( 3-DCRT and IMRT/VMAT)

5. Intensity Modulated RT -IMRT

6. SBRT with abdominal compression

7. Tomotherapy Unit; MRI Linac Unit

8. Gammaknife Unit and Cyberknife Unit

9. follow-up appointments and side effects (toxicities)

NAO

Secondary Bibliographie:

Boustani, Grapin, Laurent, Apetoh, & Mirjolet. (2019). The 6th R of Radiobiology: Reactivation of Anti-Tumor Immune Response. Cancers, 11(6), 860. https://doi.org/10.3390/cancers11060860
Faithfull, S. & Wells, M. (2003). Supportive Care in Radiotherapy. London: Churchill Livingstone.
Hoskin, P. (2006). Radiotherapy in Practice: External Beam Therapy. Oxford: Oxford University Press.
Heinzerling, J. H., Hampton, C. J., Robinson, M., Bright, M., Moeller, B. J., Ruiz, J., Prabhu, R., Burri, S. H., & Foster, R. D. (2020). Use of surface‐guided radiation therapy in combination with IGRT for setup and intrafraction motion monitoring during stereotactic body radiation therapy treatments of the lung and abdomen. Journal of Applied Clinical Medical Physics, 21(5), 48–55. https://doi.org/10.1002/acm2.12852
International Atomic Energy Agency (IAEA). (n.d.). Radiotherapy. Human Health Campus. Retrieved July 26, 2023, from https://humanhealth.iaea.org/HHW/MedicalPhysics/Radiotherapy/
Lahmi, L., Mamzer, M.-F., Burgun, A., Durdux, C., & Bibault, J.-E. (2022). Ethical Aspects of Artificial Intelligence in Radiation Oncology. Seminars in Radiation Oncology, 32(4), 442–448. https://doi.org/10.1016/j.semradonc.2022.06.013
Leech, M., Coffey, M., Mast, M., Moura, F., Osztavics, A., Pasini, D., & Vaandering, A. (2017). ESTRO ACROP guidelines for positioning, immobilisation and position verification of head and neck patients for radiation therapists. Technical Innovations & Patient Support in Radiation Oncology, 1, 1–7. https://doi.org/10.1016/j.tipsro.2016.12.001
Mast, M., & Perryck, S. (2022). Introduction to: Surface Guided Radiotherapy (SGRT). Technical Innovations & Patient Support in Radiation Oncology, 22, 37–38. https://doi.org/10.1016/j.tipsro.2022.04.004
Moore, K., Agur, A. M. R., & Dalley, A. F. (2014). Anatomia Orientada para a Clínica (N. GUANABARA, Ed.; 7a). NOVA GUANABARA.
Perez & Brady’s Principles and Practice of Radiation Oncology (Perez and Bradys Principles and Practice of Radiation Oncology) 7ª Edição (2018)
Khan, FM (2020). The Physics of Radiation Therapy. 6a ED., Lippincott Williams & Wilkins.
Zhao, W., Shen, L., Islam, M. T., Qin, W., Zhang, Z., Liang, X., Zhang, G., Xu, S., & Li, X. (2021). Artificial intelligence in image-guided radiotherapy: a review of treatment target localization. Quantitative Imaging in Medicine and Surgery, 11(12), 4881–4894. https://doi.org/10.21037/qims-21-199